Aarons, Helena Rose; (1997) Psychological factors in recovery following arthroplasty and arthroscopy. Doctoral thesis (Ph.D), UCL (University College London).

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Abstract

Arthroplasty and arthroscopy are now commonplace orthopaedic procedures carried out on large numbers of patients, with rapidly increasing demand. Although previous studies have examined long-term outcome, there is little information on psychological and functional recovery in the first weeks and months following this surgery. The role of positive thought processes in recovery following orthopaedic surgery, including optimism and a 'fighting spirit' have not been examined, although cancer research has indicated that patients showing a 'fighting spirit' actually live longer. Following many surgical procedures there is a pronounced feeling of tiredness, termed 'postoperative fatigue syndrome'. Although well known to surgeons, this phenomenon is little understood and a physical cause for continued fatigue after surgery has not been found. Therefore, the possibility was considered that it may be based on psychological changes or processes. Postoperative fatigue has not previously been assessed following arthroplasty. Following a review of the literature. Study 1 examined patient's short-term recovery following hip and knee arthroplasty. A number of psychological factors were linked with improved recovery after surgery. In the short term these included having a less negative mood and a higher fighting spirit. By follow-up having an optimistic outlook on life; maintaining, overall, a more positive than negative mood, having a fighting spirit, and a belief in one's personal control over life situations, rather than feelings of helplessness predicted better recovery. Preoperative levels of fatigue predicted postoperative fatigue as well as some aspects of short and longer term recovery. Fatigue did not increase significantly following arthroplasty. Recovery was slower for knee patients, who reported greater pain throughout the study period than hip patients. Study 2 explored recovery during the first seven days, and at six weeks following day surgery knee arthroscopy. Preoperative levels of fatigue again predicted postoperative fatigue as well as some aspects of short and longer term recovery. Fatigue was associated with distressed mood which supports the view that fatigue may be a link between psychological and somatic processes. Although patients achieved significant relief from pain and many symptoms following arthroscopy, there was a very low rate of satisfaction, which was related to worry about the eventual functional outcome. In Studies 1 and 2 patients reported many difficulties with completion of the measure for optimism, and similar problems occurred for fighting spirit in Study 1. Study 3 therefore investigated whether simple numerical rating scales measuring state and trait optimism and fighting spirit are suitable to use during the perioperative period. Results suggested that optimism could be successfully measured using a numerical rating scale, although further validation work was necessary. There was no association found between the fighting spirit measure and the numerical rating scale. Therefore, the development of a measure for fighting spirit related specifically to recovery following surgery was recommended. The focus of Study 4 was to see whether providing patients with psychological social support in the form of caring, through listening, showing concern and interest in the patient's well-being, improved their fighting spirit and mood and therefore their recovery. It was not definitively shown that social support had a positive outcome on recovery and probable reasons for this are discussed, including the possibility that both groups may have benefited from support. Recovery was again slower for knee patients compared to hip patients. In comparison to Study 1, fatigue was found to increase significantly following arthroplasty in this study, and recommendations for a further study to clarify this are made.

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